Patients dismissal of trivial symptoms could delay cancer diagnosis

People who dismiss their symptoms as trivial or worry about wasting the doctor’s time may decide against going to their primary care physician (PCP) with red-flag cancer warning symptoms, according to a study published in the British Journal of General Practice (2015; doi: 10.3399/bjgp15X683533).

Others might decide not to get possible cancer symptoms checked out because they fear a cancer diagnosis; they adopt a stiff upper lip; they lack confidence in the healthcare system; or they think their problem is due to aging.

Researchers with Cancer Research UK in London and Hull in the United Kingdom looked at how people who experience possible cancer symptoms decide whether or not to seek medical help. They sent out a health survey that was completed by more than 1,700 people, ages 50 years and over, from three London PCP practices, known as general practitioners (GPs) in the United Kingdom.

The survey specifically did not mention cancer, but incorporated a list of 17 symptoms including 10 cancer alarm warning signs, such as persistent cough or hoarseness, unexplained lump, persistent change in bowel or bladder habits, and a sore that does not heal.

More than 900 people reported having at least one alarm symptom during the past 3 months. Researchers carried out in-depth interviews with almost 50 of them, almost half (45%) of whom had not seen their PCP about their symptoms.

One woman with persistent abdominal pain did not go for a recommended test. She said, “At times I thought it was bad … but when it kind of fades away, you know, it doesn’t seem worth pursuing really.”

A man, who experienced a persistent change in bladder habits, said, “You’ve just got to get on with it. And if you go to the doctor too much, it’s seen as a sign of weakness or that you are not strong enough to manage things on your own.”

“Many of the people we interviewed had red flag symptoms but felt that these were trivial and didn’t need medical attention, particularly if they were painless or intermittent,” said Katriina Whitaker, PhD, a senior research fellow at University College London during the study.

“Others felt that they shouldn’t make a fuss or waste valuable NHS resources. The stiff-upper-lip stoicism of some who decided not to go to their doctor was alarming because they put up with often debilitating symptoms. Some people made the decision to get symptoms checked out after seeing a cancer awareness campaign or being encouraged to do so by family or friends—this seemed to almost legitimize their symptoms as important.”

Reasons people gave for deciding to seek help included symptoms not going away, instinct that something was not right, and awareness or fear that they might have cancer. However, fear also made some people decide not to check out symptoms, or if symptoms did persist some people began to think they were normal for them.

“The advice we give is: if in doubt, check it out – this would not be wasting your GP’s time. Often your symptoms won’t be caused by cancer, but if they are, the quicker the diagnosis, the better the outcome,” said Dr. Richard Roope, Cancer Research UK’s GP expert.

“Seeking prompt advice from your GP [PCP] about symptoms, either on the phone or during an appointment, could be a life-saver, whatever your age. And the good news is that more than half of all patients diagnosed with cancer now survive for more than 10 years.”